COVID-19 Patient Screening

We screen patients upon arrival to our office using this form. We will take your temperature using a touchless thermometer and provide hand sanitizer.

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Please review this form prior to your appointment to expedite the process. Please do not enter our facility if you answer "yes" to any of the marked questions. 

 

You do not need to print this form.

 

Please remember to bring a mask with you to your appointment.

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Thank you!

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